Perimenopause and menopause alternatives to conventional HRT for symptom management - Women's Health Update

Townsend Letter for Doctors and Patients, Nov, 2002 by Tori Hudson

Numerous other botanicals have been used historically in the practice of traditional herbal medicine for the treatment of menopausal symptoms. Some either have no research, no confirming research, or only a small study showing some efficacy. They include wild yam, dong quai, licorice, chaste tree, kava, sage, hops and more.

For other individual symptoms, considerations include St. John's wort to treat mild to moderate depression. (36,37) Kava can treat anxiety and hot flashes, (38) and ginkgo improves memory. (39)

Selected nutrients

Individual nutrients have been used for specific perimenopausal symptoms. Supplements such as vitamin E to decrease hot flashes, (40,41) bioflavonoids and vitamin C have been shown to treat hot flashes, (42) melatonin, L-tryptophan and 5-hydroxytryptophan for insomnia, vitamins B6, folic acid and B12 for depression, and glucosamine sulfate, borage oil and chondroitin sulfate for joint pains.

Natural Hormones

Natural hormones are by definition, defined as a plant-derived compound that has been converted in the manufacturing laboratory to a hormone and the end product is biochemically identical to endogenous hormones. Estradiol, estriol, estrone, progesterone, and testosterone are sex steroid hormones that can be made as natural hormones.

Non-natural hormones include plant derived compounds that are then made into non bio-identical hormones such as esterified estrogens or ethinyl estradiol, animal hormones such as conjugated equine estrogens and synthetics such as medroxyprogesterone acetate (MPA) and methyl testosterone.

The natural hormones estriol and estradiol tend to be combined in a formula called a bi-estrogen formula along with progesterone and sometimes testosterone. Doses can be compounded that are equivalent to conventional hormone doses, but one of the true advantages of natural hormones is that many different formulations can be compounded to individually address each person's unique menopause situation or individually titrated up or down as the need arises.

Natural hormones have a shorter half life, tend to be better tolerated than other hormones, and can be combined to achieve the suggested anti-estrogen effects of estriol in the breast, (44-45) with the anti-resorptive stronger symptom relieving effects of estradiol. Natural progesterone is significantly better tolerated than MPA, and has a better effect on lipids (46) and on dilating coronary arteries. (47)

Natural progesterone by itself, can also be used very effectively in the perimenopause. Problems that can be addressed include regulating the menstrual cycle, hot flashes, night sweats, mood swings, sleep disruption, and premenstrual symptoms.

A transdermal progesterone cream was studied for its ability to control vasomotor symptoms (hot flashes )and to evaluate its ability to prevent bone loss: 102 healthy women within 5 years of menopause were randomly assigned to receive either transdermal progesterone cream or a placebo. (48) Subjects were instructed to apply a quarter teaspoon of cream (1/4 tsp contained 20 mg progesterone or placebo) to the skin daily. Each also received a multivitamin and 1200 mg of calcium. Measurements included medical history, physical examination, bone mineral density testing of the hip and spine (DEXA), thyroid (TSH), hormone (FSH), lipids profile (cholesterol, etc), and regular chemistry profile. The women kept weekly symptom diaries and were seen every 4 months for one year. Bone density and chemistry profile were repeated at the end of one year.